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Get WI DQA F-60945 2013

Illness ADA - Alcohol / drug dependent PD - Physically disabled PWC - Pregnant women who need counseling CC - Correctional clients TI - Terminally ill TBI - Traumatic brain injury List the days when residents are NOT in the facility. List the hours when residents are NOT in the facility. LICENSEE INFORMATION (Check only one box.) Governmental Proprietary City County State Tribal Voluntary Non-Profit Individual Partnership Corporation Limited Liability Co. Name - Licensee [Individual or .

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